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Serra FE, Francisco RPV, de Rossi P, de Lourdes Brizot M, Rodrigues AS. COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women. PLoS One 2021; 16:e0259911. [PMID: 34780549 PMCID: PMC8592461 DOI: 10.1371/journal.pone.0259911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. METHODS A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. RESULTS As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 - 2.50), 2.71 (1.78 - 4.13), and 2.51 (1.79 - 3.52), respectively. CONCLUSION Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.
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Affiliation(s)
- Fabiano Elisei Serra
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Patricia de Rossi
- Curso de Medicina, Universidade de Santo Amaro (UNISA), São Paulo, São Paulo, Brazil
- Gerência de Medicina Perinatal e Ginecologia, Conjunto Hospitalar do Mandaqui, São Paulo, São Paulo, Brazil
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Agatha Sacramento Rodrigues
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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de Rossi P, Cimerman S, Truzzi JC, Cunha CAD, Mattar R, Martino MDV, Hachul M, Andriolo A, Vasconcelos Neto JA, Pereira-Correia JA, Machado AMO, Gales AC. Joint report of SBI (Brazilian Society of Infectious Diseases), FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations), SBU (Brazilian Society of Urology) and SBPC/ML (Brazilian Society of Clinical Pathology/Laboratory Medicine): recommendations for the clinical management of lower urinary tract infections in pregnant and non-pregnant women. Braz J Infect Dis 2020; 24:110-119. [PMID: 32360431 PMCID: PMC9392033 DOI: 10.1016/j.bjid.2020.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/11/2022] Open
Abstract
Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI – Brazilian Society of Infectious Diseases, FEBRASGO – Brazilian Federation of Gynecology and Obstetrics Associations, SBU – Brazilian Society of Urology, and SBPC/ML – Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women. Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105 CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100 mg every 6 hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure. In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, non-antimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250–500 mg and nitrofurantoin, 100 mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3 g every 10 days, or nitrofurantoin, 100 mg (continuous or postcoital).
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Affiliation(s)
- Patricia de Rossi
- Conjunto Hospitalar do Mandaqui and Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), São Paulo, SP, Brazil.
| | - Sergio Cimerman
- Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil
| | - José Carlos Truzzi
- Universidade Federal de São Paulo (UNIFESP) and Instituto do Câncer Arnaldo Vieira de Carvalho (IAVC), São Paulo, SP, Brazil
| | | | - Rosiane Mattar
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Obstetrícia, São Paulo, SP, Brazil
| | - Marinês Dalla Valle Martino
- Faculdade de Ciências Médicas da Santa Casa de São Paulo and Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Maurício Hachul
- Sociedade Brasileira de Urologia (SBU), São Paulo, SP, Brazil
| | - Adagmar Andriolo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | | | - João Antônio Pereira-Correia
- Serviço de Urologia do Hospital dos Servidores do Estado do Rio de Janeiro and Departamento de Urologia Feminina da Sociedade Brasileira de Urologia (SBU), Rio de Janeiro, RJ, Brazil
| | - Antonia M O Machado
- Universidade Federal de São Paulo (UNIFESP), Hospital São Paulo, Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | - Ana Cristina Gales
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Medicina, São Paulo, SP, Brazil
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Ferri E, Gussago C, Casati M, Mari D, Rossi PD, Ciccone S, Cesari M, Arosio B. Apolipoprotein E gene in physiological and pathological aging. Mech Ageing Dev 2019; 178:41-45. [PMID: 30658061 DOI: 10.1016/j.mad.2019.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/02/2019] [Accepted: 01/15/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The genetic background plays a role on longevity. The distribution of the apolipoprotein E gene (APOE) variants (ε2, ε3, ε4) may differ across age groups, especially in the oldest old and despite geographical and ethnic specificities. Since the ε4 variant is associated with Alzheimer's disease (AD), it might represent an opportunity for exploring the relationship of APOE with physiological and pathological aging. AIM To explore the role played by APOE genotype/alleles on physiological and pathological brain aging. MATERIALS AND METHODS The study was conducted in a cohort of centenarians (n = 106), and two cohorts of octogenarians (without cognitive decline, n = 351 controls; and with AD, n = 294). RESULTS No significant differences in genotype/allele distributions were observed comparing controls to centenarians. The prevalence of ε2/ε3, ε3/ε3, ε3/ε4 and ε4/ε4 genotypes were significantly different in centenarians compared to AD. The prevalence of ε2 and ε3 alleles were significantly higher in centenarians, whereas the ε4 was less frequent. The ε4 allele was positively associated with AD, whereas a negative association was found for ε2 and ε3 alleles. CONCLUSIONS Our study indicates that ε4 allele is strongly associated with AD. APOE significantly affects AD risk, but apparently not longevity.
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Affiliation(s)
- E Ferri
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy.
| | - C Gussago
- Department of Clinical Sciences and Community Health, University of Milan, Via Pace 9, 20122 Milan, Italy.
| | - M Casati
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy.
| | - D Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Via Pace 9, 20122 Milan, Italy.
| | - P D Rossi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy.
| | - S Ciccone
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy.
| | - M Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Via Pace 9, 20122 Milan, Italy.
| | - B Arosio
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Via Pace 9, 20122 Milan, Italy.
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Cerasoli B, Canevelli M, Vellucci L, Rossi PD, Bruno G, Cesari M. Adopting a Diary to Support an Ecological Assessment of Neuropsychiatric Symptoms of Dementia. J Nutr Health Aging 2019; 23:614-616. [PMID: 31367724 DOI: 10.1007/s12603-019-1209-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neuropsychiatric symptoms (NPS) are one of the most challenging issues in the management and care of people with dementia. Their accurate assessment is thus crucial for properly approaching subjects with cognitive disorders in the clinical setting. In parallel, the correct evaluation of NPS is also particularly relevant in the research field where they serve as critical indicators for measuring the efficacy of interventions against cognitive disorders. However, the study of NPS is extremely challenging given their extreme inter- and intra-individual variability. Moreover, the available assessment tools are often inadequate to fully capture their complexity and phenotypic expression. Based on these considerations, novel modalities for the assessment and measurement of NPS may be important to identify and develop. In this regard, a promising alternative (or, at least, a complementary aid) to traditional scales and questionnaires might be constituted by diaries. In the present article, we discuss the potential advantages and implications that may result from the adoption of this kind of instruments for the ecological assessment of NPS in subjects with dementia.
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Affiliation(s)
- B Cerasoli
- Marco Canevelli, Department of Human Neuroscience, "Sapienza" University of Rome, Viale dell'Università 30, 00185 Rome, Italy, Tel/fax +39 (0)6 49914604;
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de Rossi P, Bernardo WM. Update on uncomplicated urinary tract infection (UTI) in women: diagnosis. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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de Rossi P. Clinical outcome of fascial slings for female stress incontinence. Medscape Womens Health 2002; 7:1. [PMID: 12142854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
We studied 27 women with urodynamically proven stress urinary incontinence who had undergone surgery using fascial sling technique. During a mean follow-up of 20 months, all patients were continent. We observed a significant statistical reduction of urge symptoms. De novo detrusor hyperactivity and sensitive urgency were observed in 7.4% and 3.7% of patients, respectively. Two patients developed urinary flow problems. One patient had a bladder perforation during dissection. Urinary retention was observed in 3.7% and resolved spontaneously in 48 hours. We conclude that in the treatment of female urinary stress incontinence, slings promote clinical cure with few complications.
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